CPR quality during out-of-hospital cardiac arrest transport

Sheldon Cheskes; Adam Byers; Cathy Zhan; P Richard Verbeek; Dennis Ko; Ian R Drennan; Jason E Buick; Steven C Brooks; Steve Lin; Ahmed Taher; Laurie J Morrison; Rescu Epistry Investigators

doi:10.1016/j.resuscitation.2017.02.016

CPR quality during out-of-hospital cardiac arrest transport

Resuscitation. 2017 May:114:34-39. doi: 10.1016/j.resuscitation.2017.02.016. Epub 2017 Feb 24.

Authors

Affiliations

¹ Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada; University of Toronto, Department of Family and Community Medicine, Division of Emergency Medicine, Toronto, ON, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada. Electronic address: Sheldon.Cheskes@sunnybrook.ca.
² Rescu, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada.
³ Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada; University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, ON, Canada.
⁴ Sunnybrook Health Sciences Centre, Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada; York Regional Paramedic Services, Toronto, ON, Canada.
⁶ Sunnybrook Centre for Prehospital Medicine, Toronto, ON, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada.
⁷ Rescu, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada; Department of Emergency Medicine, Queen's University, Kingston, ON, Canada.
⁸ University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, ON, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁹ University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, ON, Canada.
¹⁰ University of Toronto, Department of Medicine, Division of Emergency Medicine, Toronto, ON, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michaels Hospital, Toronto, ON, Canada.

PMID: 28242210
DOI: 10.1016/j.resuscitation.2017.02.016

Abstract

Background: Previous studies have demonstrated significant associations between cardiopulmonary resuscitation (CPR) quality metrics and survival to hospital discharge. No adequately powered study has explored the relationship between location of resuscitation (scene vs. transport) and CPR quality.

Methods: We analyzed CPR quality data from treated adult OHCA occurring over a 40 month period beginning January 1, 2013 from the Rescu Epistry-cardiac arrest database. High quality CPR was defined as chest compression fraction (CCF) >0.7, compression rate >100/min and compression depth >5.0cm. Our primary objective was to compare the proportion of resuscitations for which all CPR quality benchmarks were met between scene and transport phases of resuscitation. Our secondary objectives were to compare the quality of CPR between the scene phase and transport phase of resuscitation.

Results: The proportion of patients with high quality CPR was similar on scene compared to during transport (45.8% vs. 42.5%; ∆ 3.3 %; 95% CI: -1.4, 8.1). Regarding individual CPR metrics, median compression rate was higher on scene compared to transport (105.8 compressions per minute (cpm) vs. 102.0cpm; ∆ 3.8cpm; 95% CI: 2.5, 4.0), while median compression depth (5.56cm vs. 5.33cm; ∆ 0.23cm; 95% CI: 0.12, 0.26) and median CCF (0.95 vs. 0.87; ∆ 0.08; 95% CI: 0.07, 0.08) were higher during the transport phase.

Conclusions: High quality CPR metrics were similar in both (scene and transport) locations of resuscitation. These results suggest that high quality, manual compressions can be performed by prehospital providers regardless of location.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Emergency medical services; Paramedic; Resuscitation; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Benchmarking / methods
Cardiopulmonary Resuscitation / standards*
Cardiopulmonary Resuscitation / statistics & numerical data
Databases, Factual
Emergency Medical Services / standards*
Emergency Medical Services / statistics & numerical data
Female
Heart Massage / standards
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Prospective Studies
Quality of Health Care*
Time Factors